The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective, randomized clinical study

Abstract

Background: Although colonoscopy plays an important role in postoperative surveillance of patients with colorectal cancer, the optimum protocol for colonoscopic surveillance has not been established.

Objective: Our purpose was to compare the efficacy of 2 different colonoscopic surveillance strategies in terms of both survival and recurrence resectability.

Design: Prospective, randomized, controlled trial.

Setting: A teaching hospital in Sun Yat-sen University.

Patients: Three hundred twenty-six consecutive patients undergoing radical surgery for colorectal cancer.

Intervention: In the intensive colonoscopic surveillance group (ICS group, n = 165), colonoscopy was performed at 3-month intervals for 1 year, at 6-month intervals for the next 2 years, and once a year thereafter. In the routine colonoscopic surveillance group (RCS group, n = 161), colonoscopy was performed at 6 months, 30 months, and 60 months postoperatively.

Main outcome measurements and results: The 5-year survival rate was 77% in the ICS group and 73% in the RCS group (P > .05). Postoperative colorectal cancer was detected in 13 patients (8.1%) in the ICS group and in 18 patients (11.4%) in the RCS group. In the ICS group, there were more asymptomatic postoperative colorectal cancers (P = .04), more patients had reoperation with curative intent (P = .048), and the probability of survival after postoperative colorectal cancer was higher (P = .03).

Limitation: Lack of detailed characterization of metachronous colorectal adenomas in these patients.

Conclusions: Although the patients in the ICS group had more curative operations for postoperative colorectal cancer and survived significantly longer, ICS itself did not improve overall survival.